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Counterfeit Electronic Components
Avoidance Workshop
June 26, 2007
Components Technology Institute, Inc.
904 Bob Wallace Avenue / Suite 117, Huntsville, AL 35801
Registration Information
Name _____________________________________________ Title_________________________________
Company ________________________________ Division _______________________________________
Address _____________________________________________________ M/S or Suite # _______________
City ____________________________________________ State/Prov _____ Postal Code ______________
Country _______________________ Phone ________________________Fax ________________________
Email __________________________________________________________________________________
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After June 19 |
| Registration Fee Payment |
$395 _________ |
$445 _________ |
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3 or more from same company at same time: Deduct $ 45 ea. |
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Total |
____________ |
Payment must accompany registration. Registrations without payment will not be processed.
Company checks must be made out to Components Technology Institute, Inc. and payable in US dollars
drawn on a US bank. Credit card payment requires cared number expiration date, and signature.
Only substitutions are accepted after registration is received. FAX THIS FORM TO: 256-539-8477
Payment Method: _____ AMEX _____ VISA _____ MC _____ Check
Card Number: _________________________________________ Exp. Date: _________________________
Name on Card: ___________________________________________________________________________
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